Pain Medications: Are You Asking the Right Questions?

Pain Medications: Are You Asking the Right Questions?

I know how emotionally charged the topic of pain medications can be. This is one subject that usually garners strong opinions from pain patients, their doctors, pharmaceutical companies, the insurance world, and now even the military and our government. But certainly those who suffer with chronic pain carry the strongest sentiments about their medications. And I know this is an area that is frequently met with deep dissatisfaction by patients.

As a pain expert for WebMD and with my eighteen years of private practice experience, I know that pain patients across the country are often unhappy with their medication situation, including how much relief they get, the way they get treated, and even with their doctors.

bigstock-Asian-American-male-doctor-exp-12827732In fact, I have even seen a few pretty rough reviews on the internet of yours truly by patients who were not satisfied with my own medication recommendations for them.

Needless to say, I know the hornets’ nest you can walk into when you start giving opinions and advice about pain medications, so please be gentle with me.

The first step in discussing pain medications as a general topic is to clarify the context. In other words, there are differences between acute pain and chronic pain, and there is a wide spectrum of chronic pain problems from fibromyalgia, to sciatica, to arthritis, to neuropathy and so forth.

One of the biggest differentiators between acute pain and chronic pain is that with acute pain we are talking about very short term treatment, but when it comes to chronic pain, medications may be used for years or even decades. The implication here is that there is a big commitment involved when something is used for years at a time, and there should be a sound grasp of the potential side effects, complications, and pitfalls.

View Your Body as a Temple

In my book “Take Charge of Your Chronic Pain,” one of the key elements of successful pain management that I identified was taking on the philosophy of viewing your body as a temple which means being extra careful about what you put inside it. That includes giving importance to good nutrition, proper hydration with clean water, and even breathing fresh clean air. This mindset should also apply to the medications that you ingest. If you want to be healthy, active, happy, and thrive, then it stands to reason that part of getting there means ingesting high quality molecules to support that transformation.

When it comes to medication choices and decisions, try adopting the perspective that your body is a very special place and you want to be real clear that what you are putting into it is going to help you go in the direction that you want both in the short term and for the years ahead. Both you and your doctors need to think through the potential long-term implications of staying on any particular medication for an indefinite time period. Will the benefits outweigh the risks?

Sometimes doctors feel pressured to prescribe pain medications at office visits or do so out of habit. A great question to ask your doctor when he or she recommends any treatment or medication is “Doc, if I was you or your spouse in my situation is that what you would want to do?” The answer to this should be “yes,” and if it isn’t then perhaps the plan should be re-evaluated before proceeding.

Be a Scientist

As you probably can appreciate, there is an awful lot to pain and treating pain that is poorly understood. I have seen many patients over the years with terrible pain problems where none of their doctors could figure out what was going on. Many times, medications get tried out of desperation or hope without clear scientific support. That isn’t necessarily a bad thing, but it is good to be clear that what is being tried is happening without clear scientific studies to back it up.

Be informed about the science or lack thereof about what you are doing. For example, one research model often used to study nerve pain is done on patients with diabetic neuropathy. If a medication studied is found to work well on diabetic neuropathy, that doesn’t mean it is scientifically proven to work on a different type of nerve pain, but you and your doctor may still decide to try it on your painful trigeminal neuralgia problem.

It is also important to think about the long-term implications of any medication that you are considering for chronic pain treatment. What are the possible side effects? Are you comfortable assuming those risks? Will tolerance develop? If you don’t see yourself being on a particular medication for a prolonged period of time, then what is the reason for starting it in the first place? Beware of trying brand new drugs — many times the worst complications don’t become realized until after they hit the market.

The Politics of Opioids

The political pendulum has swung in this country to the point that there is now a lot of controversy surrounding the safe and appropriate use of opioids. Doctors and pharmacies are under a lot more pressure and scrutiny now than they were several years ago when it comes to narcotic pain killers. This impacts patient care as well as the doctor-patient relationship. Now, urine drug screening and running prescription drug monitoring reports are a part of the daily routine for clinics and patients. The reality is that if you are on opioid-based medications, then a lot of people are looking over your shoulder.

Naturally, a big reason for this shift toward tighter regulation and compliance is to improve safety and curb the steep rise in prescription addiction problems and overdose deaths. But there are other issues surrounding prescription pain killers. For one, they are costly, and there is a good chance your insurance company is not thrilled about paying for them. In some cases, the monthly costs can run in the thousands of dollars.

Another issue which we all have to face is that there really isn’t strong scientific evidence that has been produced that has shown the long-term use of opioids to be successful for the more chronic management of pain. Everyone assumed that opioids would be a great option for challenging chronic pain problems when they became commonly available, but now we know that what works well for acute pain may not do the same for chronic pain. And we are just now starting to appreciate some of the physical, cognitive, and psychological effects of their long-term use on our patients.

Again, I’m not saying using any class of pain medication is necessarily wrong, but be informed about what that means when making choices.

Know the Alternatives

I think it is fair to view medication management as just one of many ways to treat and manage pain. Sometimes we are too quick to jump to a new medication to solve every health problem, as opposed to diving deeper to explore the root causes of a problem. Effective pain management can be much more than symptom management with medications.

For example, one way to treat a pain flare-up is to take a medication for breakthrough pain, but recognize that there are many other ways that a flare-up can successfully be handled including using stretching, meditation, diaphragmatic breathing, or massage as examples.

We don’t want medications to stand in the way of us listening to our bodies and understanding why it isn’t feeling well. Did we lift something with the wrong body mechanics? Are we flaring up because we take on more than we should? Is there extra stress at work or at home right now? Being too focused on medications can keep us away from problem solving and exploring other potentially healthy and valuable ways of managing pain.

Whether we are talking about medications or other ways of managing pain, what is important is to evaluate how these treatments support your goals, improve your well-being and help you function, both today and in the future.

Dr. Peter Abaci

Dr. Peter Abaci

Peter Abaci, MD, is certified in anesthesia and pain management by the American Board of Anesthesiology. He serves as the Medical Director of the nationally recognized Bay Area Pain and Wellness Center, located in Los Gatos, California.

Dr. Abaci focuses on developing alternative solutions to treating chronic pain by drawing on neuroscience research, evidence-based medicine, ancient healing remedies, stress management techniques, nutrition principles, exercise programs, art therapy, and real-life lessons.

This column is republished with the permission of Pain Relief Revolution.

Authored by: Peter Abaci, MD

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Andrew Lomac-MacNair

What has been clearly lacking during the DEA’s–a non-medical agency–pressuring the FDA to recategorize most pain medications as Schedule II drugs is the chronic pain sufferer’s voice. The media have sensationalized the rise in pain medication abuse to such a degree that any person voicing a simple alternative opinion is deemed a worthless addict. I used to believe that The United States was an innovative nation, one that prided itself in solving problems. And yet, not a single alternative process has been presented to allow severe, chronic pain sufferers simple methods of obtaining relief. A commonsense system based on patient-by-patient needs should replace the drug classification currently used. A patient with a sprained ankle obviously doesn’t have a need for long-term prescriptions. Conversely, a patient with fibromyalgia, neuropathy, or cancer should not have to go every single month to a pain management clinic, pay additional fees, wait an hour to be seen, go to the pharmacy where they are scrutinized by unqualified register clerks, and hopefully get their prescriptions filled.

JenC

As soon as I see the “expert” claim of food as the answer, I’m clicking away from any further regard of this “expert.” Too many of us have spent our lives eating right, exercising, working hard, all to have our bodies STILL FAIL! This is just glorified “blame the patient” and don’t forget the “experts” quest for millions in the bank. How soon do we blame the child for being born with Type1 diabetes? Let’s see them and their “temple” eat & exercise their way out of diabetes. Oh, wait, let’s go one further & blame the child for having the wrong parents. All you “experts” are only looking to make a fortune out of your quackery. At the expense of those suffering, committing suicide (soon to be the next epidemic) from undertreatment or no treatment, begging for diagnostic testing, for YEARS, yet not getting any at all to find that so talked about “underlying cause,” then it’s TOO LATE & no amount of foods, exercise or meditating (hard to do as it requires being still & relaxed, impossible if writhing about in pain) are going to do a damn thing, because the “experts” disbelieved and ignored the patient till it was too late! And if it’s painful, have some Advil or Tylenol? Does any “expert” realize that we show up at the “experts” office because the Advil or Tylenol that took care of everything no longer works, not because we suddenly decided we wanted to “take drugs?” You call bottles & bottles of OTC NOT “drugs?” Bottom line is all this nonsense is about the “experts” bottom line, from Doctors to the DEA. $$$$ (I’m also sure this comment will be viewed as just an upset addict who can’t get their fix. Let me assure you, I used narcotics till my pain luckily improved & I naturally reduced intake, funny how that works, same as not taking Advil if no headache, duh.) But I won’t forget those millions out there still suffering with 0 help & will continue advocating for them! If the opiates are so horrible, where’s the pain killer that will work as effectively? Too busy developing erectile dysfunction drugs or the other host of frivolous meds, advertised heavily one month, then the next month, lawsuits for death, stroke, male breast growth,etc etc? Just great.

Stephen S. Rodrigues, MD

All good advice here and as I read through the “open” Amazon copy of your book.

I am sadden that the icons of chronic pain medicine from the last century were not included in the bibliography.

I’m also sadden that most of the hands-on options that were used over the millennia were not covered or only superficially.

And the last unfortunate missing segment is the vast array of old school myofascial treatments with hands-on and needles. You did not cover any of those topics. Maybe in the full book copy, I hope.

In my professional opinion, the vast array of options are absolutely necessary to break the cycling of old stale long-term pain. They are not included in the standard and cost extra which is a huge barrier that must be broken.

I noticed you mentioned PRIDE in Dallas, I will have to pay them a visit in the near future to witness their program.